Physical (psychosomatic) Problems and Hypnotherapy

Lately I've been getting a lot of calls of people saying things like,

"I can't fall asleep at night and I've seen a bunch of doctors and nothing helps, even medication. Can you see me?" Or

"I get these terrible headaches but the doctors all say nothing is wrong with me. My acupuncturist/doctor/psychotherapist/neurologist told me to call you." or

"My hand isn't working right and nobody knows why and I've got a softball game in 3 weeks. When can you fit me in?"

These are psychosomatic complaints and they're a type of problem that hypnosis excels with. Today I thought I'd write about how I work with them.

Psychosomatic complaints: my definition

  • A problem that can't be medically explained or clearly diagnosed

  • Has a suspected or verified psychological element

  • Results in physical pain or other distressing physical problem or changes (“clinically significant distress”)

These include things like sleep problems, pain with no clear cause, injuries that haven't healed when they should have, unexplained paralysis or numbness, teeth grinding during sleep (nocturnal bruxism), irritable bowel syndrome, non-biological erectile dysfunction, vaginismus, fainting with no cause, and all sorts of other problems that make doctors say, "I don't understand. That shouldn't be happening."

I should say immediately that I only work with people who have gotten checked out by their doctor and no clear medical problem has been found. Often I'll even encourage second or third opinions. Many of the problems I've listed could have potentially significant medical consequences if not evaluated seriously. To give just one common example (I could give many from the above list alone): night time teeth grinding can be a symptom of sleep apnea and warrants a medical check and possibly a sleep study before pursuing hypnosis treatment.

The Purpose of a Symptom

Sometimes doctors will tell you, "The problem is all in your head." As if that's a helpful thing to say. Aside from ignoring much of the contemporary understanding of reality, such a statement ignores the actual purpose of the problem. "Purpose," you may be thinking, "we're talking about a migraine. What purpose could it be serving?"

I'd like to tell a story I heard once to illustrate.

Ignoring a Stone wall

Once upon a time, there was a civil engineer who was annoyed at a particular place in a road he had to take regularly where the road turned sharply to the right and avoided ahat appeared to be an empty field. After going for half a mile, the road turned back and resumed a path almost exactly where it had been going before. In front of the field, in the place where the road turned, was an old stone wall. A few times a year, cars would miss the turn and run into the stone wall. He decided he could fix this problem and prevent accidents.

So, the engineer convinced the town and the road crews to bulldoze the stone wall and build the road through the old field. The owner of the field was more than happy to sell that stretch of land, and by the end of the summer, they'd made a perfect straight road where there'd been a curve before.

In his excitement, however, the engineer failed to notice that the water table was particularly high in that section. When winter came, the road began to crack from all ice underneath it, and by spring, it was buckled and ugly. By the second spring, it was practically gravel and quite dangerous: many more cars skidded off the road than had missed the turn before, and by the third year, the stretch of road had practically disintegrated back into the marshy field around it. The town got so many complaints it opened up the old section again. Eventually motorists started putting rocks and boulders in the straight stretch of road to warn people away from going down that dangerous section, and eventually good Samaritans replaced the haphazard rocks and boulders with a proper country stone wall.

In the story, the civil engineer represents how we usually think. While perhaps an actual civil engineer would have consulted water tables or historical records before trying to build a road, when it comes to problems with our bodies and physical or psychological symptoms, we're rarely so thoughtful. The curve in the road and the stone wall represent symptoms: we don't know why they're there. They just are, and they do create problems: migraines, IBS, teeth grinding, fainting - whatever the problem - isn't without cost. But what the story is trying to illustrate is that they aren't random, just like the original road and stone wall weren't random. If there's no obvious physical reason for a problem, it behooves us to look deeper. And that's one of the things hypnosis treatment can do well.

Typically, purposes served by psychosomatic problems have to do with self-protection, interpersonal dynamics or other unconsciously tended areas.

For instance, suppose a young boy would lie awake every night as a child because his parents would fight after tucking him in. Sometimes they'd be particular violent and he felt he had to stay awake in case something really bad happened and he had to call the police or help. Imagine that the same boy has grown up and as an adult, has terrible trouble falling asleep and is filled with inexplicable dread of going to bed in general. The problems are so bad that regular doses of medication don't really help. The guy calls me one day and says "I'm having sleep problems." You see how the "sleep problems" serve a purpose?

Or suppose a young girl experiences subtle disapproval from her father whenever she does something, "un-lady-like." This extends as far as his disapproval when she signs up for advanced math classes, which her father judges harshly. Years later, her father dies and she finds herself feeling dizzy and anxious whenever she goes to her job, where she works as an engineer. She gets a cardio work up and monitors her blood pressure for a week and everything's normal. Could it be that her unconscious, galvanized by her father's death, is trying to keep some sense of connection to him?

Or, imagine a high school student who is getting bullied. He begins to get stomach aches before lunch, when he usually is harassed. Eventually the stomach aches are bad enough that he can't eat lunch at all. Even as an adult, in times of stress, he finds he can't eat. If he tries, he has almost immediate diarrhea and cramps, sending him to the bathroom. Aside from a diagnosis of IBS-D, he hasn't gotten any clear explanation or any relief from his doctors.

I realize I'm telling these stories a bit backwards — If you're dealing with a problem like this, there likely isn't a clear history to explain it: there's just diarrhea, or there's just sleeplessness, or grinding teeth -- just like in the story, where there's just a bend in the road and the stone wall. This is the nature of the way we relate to our unconscious minds in modern times. But even if there is a story of why the problem is there, it's not like knowing it fixes the problem. So let's move more into what to actually do to help things.

Specific ways I work with psychosomatic issues

Many of the same things that help other problems, such as anxiety, can help with psychosomatic complaints. For instance, anchoring and things that bolster a sense of inner strength and resources help many psychosomatic complaints. Mindfulness meditation and loving kindness practice are good easily accessible home practices. Likewise, specially tailored direct suggestions can be very helpful, as can the Turner Age Regression I talked about in my last entry.

Another approach I take with psychosomatic problems is called ideomotor finger signaling. It's a technique that allows for communication with the deep unconscious. To explain, let's clarify the goal. Suppose in the story I told earlier, the civil engineer could have consulted with the person who built the original stone wall. The two might have a conversation about water table and the hazards of building a road through that section, but also about the problems that are caused by the solution -- the accidents caused by having the sharp turn and the stone wall there. Ideally, they could come up with a better solution together than either could have on their own: maybe turning the road more gradually, or having a bridge there instead of a regular road. This is what we’re after. The best solutions to problems are the result of conversations between both our unconscious mind and conscious mind — or, you might say, all the parts of ourselves. Ideomotor finger signaling is a relatively easy way to facilitate that conversation.

Basically the ideomotor technique involves me training a client to listen in deep trance to the body's response when I ask yes or no questions and to use their fingers to non-verbally signal responses. The signals put language to a kind of deep gut feeling. Suppose you look at a menu at a restaurant -- you might have a gut feeling that you'd like one thing and not another. You look at the fajita description on the menu and some part of you says "yes!" and you look at the burrito description and it says, "no!" The part of you that is responding is usually your unconscious, and in a deep hypnotic state, it's your deep (somatic) unconscious. So if I ask, "Do you sense that the teeth grinding is somehow self-protective?" the client, who is in a deep trance, checks in with a kind of gut feeling and, if the answer is yes, one finger moves, if no, another finger does. (there are also fingers for "maybe," "I don't know," and "I don't want to say at the moment.") Moving a finger is easier than talking out-loud in trance states, and so require less practice. With a little bit of practice, though, the deep unconscious / body responds directly to the questions. This allows for a relatively unmediated conversation about the problem, and potentially a way to find a better solution.

There is much more I could say about this technique. If you're a clinician and want to read more about it, this book is a good place to start. The main author, Dabney Ewin, is a physician that has used ideomotor signaling with astounding results for decades.

Next I'll be talking about habit change and hypnotherapy.

Modern Traumawork in Hypnotherapy

For those of you who like your blog entries brief and to the point, here are the main points:

* The trauma treatment modality I use is an age regression technique where you go back as your present day self to help the young part of you that has been traumatized. This way of age regressing is called hypermnesia and is different than how age regression (and a lot of traumawork in general) usually happens, which is called revivication.

* This technique, which I call the Turner Age Regression (after Maureen Turner, its originator), tends to be less overwhelming than techniques that depend on revivication / abreaction.

* However, like any trauma work, it still requires preparation. In particular, this technique depends on (a) stable, deep trance and (b) self-compassion: the willingness to accept, love and care for yourself, especially the younger self that was traumatized.

* The science behind this technique is pretty clear: in deep hypnosis, we access trauma imprints are stored in the midbrain (I talk more about the amygdala and the periaquaductal gray nucleus below). Sensorimotor Psychology therapist Janina Fischer talks about this in her book, Healing the Fragmented Selves of Trauma Survivors. While she's talking about somatic therapy, it seems reasonable to me (and Maureen) that deep hypnosis allows even clearer access to this unconscious area.

* Advantages of this method: humane, utilizes a person's own healing capacity, and fast and effective once the preliminary preparation is done.

More detail

Age regression

Like hypnosis as a whole, age regression brings up some weird ideas for people. Let's get those out of the way first.

Am I talking about going back to your past lives, when you were a pirate or the despotic Queen of Prussia?


Am I talking about remembering when you were abducted by aliens?

Very very unlikely.

Does it involve remembering things that never happened?

Argh. No-- more about that later.

But, age regression is when you go back to something in your past. And there are two ways it happens. It can either happen as a revivication or as a hypermnesia.

A revivication, like the word suggests, is when you go back and relive an experience. Sometimes people do this in dreams. Or, they do it unbidden, in traumatic flashbacks. Somethings they relive positive experiences and it’s a good time. Reliving and working through past trauma is the classic "method" of trauma work has worked since time immemorial. Even before we had a name for hypnosis and before we had ideas like psychological trauma, people were reliving experiences to confront and overcome overwhelming past experiences. This happens quite naturally. Unfortunately, however, since time immemorial, people have also been re-traumatized and their symptoms worsened by revivication if not done or prepared for properly.

Because of it's so tricky to do well, for a long time, new trauma modalities involved new ways to "control the abreaction." Abreaction basically refers to the huge upwelling of emotional energy (adrenaline, fear, disgust, shame, terror, among others) that comes up when reliving a trauma. Essentially, all trauma work that primarily utilizes revivication / abreaction involves slowing the process, going through the whole thing slowly, carefully, in chunks, or sections, or in a special way, so this isn't overwhelming.

After Freud poopoo'd hypnosis and as the western world has embraced Cognitive Behavioral Therapy, the hypnotic methods of trauma work have been mostly ignored. Instead, other, non-hypnotic methods were developed. However, for a long time, they all basically follow the same rules as these original abreactive methods: You re-vivify a past experience, but do it in a controlled manner. However, because they don't involve deep trance, you also have to do it over and over again. EMDR has become the gold standard for this for a couple reasons: first, it's easy to learn for clinicians (especially compared to hypnosis) and second, because it controls that abreaction reasonably well and in a non-trance (or light trance) state. I'm sure EMDR therapists will read this and say I'm unfairly lumping EMDR in with all that came before. So to be clear, let me say it's possibly the best abreactive trauma method: you don't have to talk about everything, and you're mostly just focusing on the worst part of the traumatic memory. But it's still based on revivication and abreaction and has many of the same problems: it takes a lot of inner resources and strength to go confront demons from the past, repeatedly taking bites out of them and slowly digest them in pieces. Typically trauma work is done in a series of phrases. Actually working with the trauma is "phase II." "Phase I" is the preparatory work. (For those who are curious, there's also a Phase III, and it's about moving on and establishing meaningful life now that you've dealt with the trauma.)

More recently, trauma modalities that aren't abreactive in function have come on the scene. These are therapies that don't require the processing or re-living of traumatic events to get over them. The hypnosis modality that I use to treat trauma is one of these new kinds of trauma therapies.

Hypermnesia Age Regression: going back with new information

Hypermnesia means vivid remembering. This is another way to go back to a past experience. In hypermnesia, you go back as your current day self and you're there with your past self, the one going through something traumatic. It's a third person stance, not first person.

To give a flippant example:

Revivication is like Luke Skywalker reliving the seminal reveal of modern cinema where Darth Vader says, "Luke! I am your father!" -- If Luke did an abreaction-based therapy, he'd do a lot of preparation, then he'd have to relive that moment, feeling all the complex feelings (humiliation? anger? sadness? love? shame?) in therapy until it wasn't overwhelming anymore -- until all the emotions were processed through. If he was doing Prolonged Exposure, he'd be telling the story outloud over and over. If he did EMDR, he'd just do in his mind while getting bilaterally stimulated in some way. If he was doing an old-school hypnosis trauma method, he would do it intensely, probably just once or twice and the therapist would advise him to slow it down, rewind, skip ahead, to wear impenetible magic armor, while doing it and the like. But he'd still be re-vivifying it using all these methods.

Hypermnesia, on the other hand, is like Luke going back to the scene and seeing it with older, wiser eyes that are informed by everything that comes after and how everything turns out in the end. So Luke goes back to that scene, but it's like "end-of-Episode-6-Luke" visiting his "Episode 5" self and saying to him, "It's true, Luke, but--don't worry! You and I are gonna get through this together and you get your father back in the end, even if it's bittersweet. Things are going to be okay!"

How it works

As I note above, I call this method the Turner Age Regression Technique, after its creator, Maureen Turner.

As you might imagine, going back to the worst events of your life isn't a good time no matter what. Rather than it being able digesting all those old feelings, though, this method hinges on your current day self's ability to be compassionate and present for the "part of you" that is still stuck in a traumatic experience.

In short, it's based on self-compassion. Luckily, self-compassion is a trainable psychological skill and has lots of benefits, including better self-care and general resiliency.

So rather than Phase I of trauma work being about training for the rigors and overwhelm of reliving some of the worst moments of life, the preparatory work in my modality involves learning how to go into hypnosis deeply, and learning how to love yourself. I regular help people develop self-compassion if they need more skill at it. I also usually suggest doing some anchoring of inner resources if that's needed. So, for instance, if a person had a terrible experience that felt out of control, we'll anchor the opposite -- an experience they felt very in control and safe, as preparation for the trauma work.

You may be thinking at this point: "this sounds interesting, but does it actually work?"

And the answer is yes.

In deep hypnosis, you can access parts of the mind that are deeply unconscious. In neuroanatomy, we know that the brain areas that are responsible for traumatic memories and imprints are in the limbic system, in and around a small walnut-sized region called the amygdala. The amygdala's job scans the environment for signs of something bad that happened in the past. Sometimes the signs aren't obvious to us consciously, and sometimes they're obvious. But when the amygdala registers those signs, it triggers alarms. People usually just call this "trauma triggering" and if you've experienced it, you probably know what I'm talking about, even if you don't know exactly what all your triggers are.

A stone age example

Imagine a prehistoric human wandering around the savanna. Imagine she sees a pretty rock formation in the distance and while she's looking at it, a lion jumps out at her and starts chasing her. Later (after she gets away from the lion), imagine she's walking around on the savanna again and she sees that same rock formation. Her amygdala is going to register that formation and scream, "lion!" -- (and not the Alan Ginsberg type). If we had a time machine and we went back and asked her if she knew why the rock formation made her feel ready to attack something (fight), want to run (flight), or made her feel like she was out of her body (freeze / dissociation), she may or may not connect those rocks to her previous incident with a lion. She may not even know she feels that way because of the rock formation. She might even be running or fainting before she's even aware of seeing the rock formation. The amygdala's concern isn't understanding -- it's self-preservation.

The amygdala still does this for us even though very few of us have to run from actual lions. Instead, we experience fight, flight and freeze responses to overwhelming social situations, to abuse, bullying, non-consentual sexual situations, assaults, drug experiences, vicarious trauma and to combat. The trigger (like the rock formation) can be anything 15 minutes before or after a traumatic event.

In the Turner Age Regression, we go deep enough that we can talk to the correlating part of the mind -- the part of the mind that's stuck watching for signs of a terrible experience from the past. We connect to that part through the original, earliest traumatic situation, and we give that part new information: for instance, that the event has passed and that it won't happen again -- that the time to be watching for another middle school bullying situation (for example) is over because middle school is over. This allows that system to relax, the triggers go away, and (in my experience) a lot of beneficial life energy is freed up.

This is hard to talk about because it seems a bit far fetched that you can get into a state of mind where you can communicate with your midbrain. It's worth noting that even non-hypnotic methods are doing this, but, because they're not in deep trance, they usually require a lot of repetition, like I mentioned earlier. With EMDR, for instance, you might go over a single incident 20 times. In Prolonged Exposure Therapy, a CBT method, you might go over it a hundred times (and if you think that's grueling, the 50-90% of military personal who drop out of this trauma treatment agree). In contrast, in deep trance, we can just communicate more directly. Done right, once is enough.

Another way of making my point is that weirder things are well-documented with hypnosis. Take, for example, cases of people communicating with their hindbrain to do things like lower their blood pressure or pulse rate, or to stop a migraine. Or even people who can block out pain (another hindbrain function) and go into surgery without anesthesia. In reality, such things are possible. Easy? Well, no. But communication reasonably directly with the limbic brain? Definitely doable with a little preparation.

In fact, I like this method so much because, after the preparation, it takes a lot less time and suffering than others I've seen. I would like to say it's easy, but no trauma work is easy. It's definitely fair to say that it's easier, though. In addition, remember how I was talking about utilization and the uniqueness of each person in a previous blog entry? This method, though somewhat directive, is unique to each person and relies on their innate wisdom and healing abilities. I've yet to see two people do this process exactly the same way. As Maureen Turner has noted, in this method, the therapist is a coach: it's the client who goes back and rescues themselves.

The only case I might recommend a different method is when the trauma is an isolated one-time event. For instance, if someone was in a car accident and it was the only traumatic thing in their life, it might be faster to do EMDR or ART, which require less preparation for simple cases: you don't have to learn how to go into deep trance -- you just maybe do a little inner resourcing and then work directly with the isolated incident. In my experience, though, most people struggling with trauma are not struggling with single events. In those with situations that are more complicated than one trauma, Turner Age Regressions are the fastest, least difficult method I've seen.

You may be thinking, "what about ___?!" where ___ is some element I haven't really addressed in working with trauma. I apologize -- I've been trying to keep this entry brief and trauma treatment is a big, complicated thing to talk about. Feel free to comment below or to raise a point with me via email.

Next I'll be talking about physical (psychosomatic) problems and hypnotherapy.

Anxiety and Hypnotherapy

Anxiety comes in many different shapes and sizes, from fears of specific things or situations (like the fear of elevators, or anxiety about social situations) to anticipatory anxiety to generalized anxiety and panic attacks. Physical problems, such as a depleted immune system, stomach complaints, high blood pressure or body tension -- often come along for the ride.

In my experience, hypnosis is good answer to anxiety problems of all kinds. Cognitive Behavioral Therapy is the “gold standard” for a lot of mental health treatment, including anxiety. As a result, if you search for treatment for anxiety, you’ll often stuff saying that CBT is the answer. Although there aren't as many studies about hypnosis and anxiety as there are about Cognitive Behavioral Therapy and anxiety, at least one study suggests that hypnosis based therapy is as effective as CBT, but that the effects are longer lasting.

Here are some talking points about hypnotherapy and anxiety treatment:

  • One reason for hypnotherapy’s effectiveness with anxiety this may be that therapeutic hypnosis states are themselves very relaxing. While there are exceptions to this rule, generally a hypnotherapist will help someone enter a relaxed, internally focused trance state in order to do hypnosis. In this kind of state, there isn’t much anxiety. In other words, just going into a hypnotic trance state -- regardless of what you do in that state -- can help with anxiety in the moment, and may help an individual’s system “reset” to a more relaxed state in general. A similar effect can be seen with yoga nidra meditations and even sometimes with samatha meditation.

  • Then, in hypnosis, many different interventions are possible. My favorites include:

    • anchoring - giving your unconscious cues that you can relax and/or reminders of competence and strength so that the anxiety feels less threatening

    • personally tailored direct suggestions to address any cause of the anxiety, like I talk about in this entry where I discuss an imaginery case of public speaking anxiety.

    • going back to the original cause of the anxiety and fixing the issue there -- I'll be talking more about this soon when I talk about hypnosis and trauma treatment

  • Other possibilities include: hypnotic exposure therapy and rehearsal (ie, using hypnosis to imagine a scary situation and it working out okay), dialogue with the "protector parts" that are triggering the anxiety in the style of Internal Family Systems or Self-Relations Therapy, or creative metaphorical interventions to reduce or remove anxiety, such as the hypnosis “control room” exercise.

The major thing that I want to convey about anxiety is that it's very treatable. Sometimes I hear people talking about living with anxiety for years and years. While it's possible that working with the anxiety may take some time, and may require additional interventions, such as temporary anti-anxiety medication, herbal supplements, or Traditional Chinese Medicine, a life where anxiety isn't a daily obstacle is very possible. There’s obviously a lot more I could say about this, but maybe I’ll stop here. If you’d like to learn more or have questions, contact me or write a comment.

Next I’ll be talking about treating trauma and PTSD with hypnotherapy.

Anchors and the Elman-Turner Induction

In this entry, I'm going to address one of the most common tools I use, anchors, and a particular protocol I use, the Elman-Turner Induction.

Here's the short of it

Anchoring is a term from Neurolinguistic Programming. Basically, what it means is something like bookmarking a psychological state or feeling. Why would you bookmark it? So you can get back to it easily, like you might bookmark a page of a book or a website that you want to return to.

In hypnosis, you can bookmark/anchor a state pretty easily, and that anchor can be a tool for having more control over how you feel or what your mind does. For instance, suppose we anchor feeling focused and oriented toward learning. You could use it when you want to study. Or say we anchored a charismatic or empowered feeling. Maybe you could use it when you’re about to do some public speaking. Or say we anchored a relaxed, chilled out kind of feeling. You can use the cue for the anchor to let your unconscious know that now is a time you can feel relaxed and at ease.

This last thing is very helpful, especially if someone’s suffering from anxiety. An anchor won’t address the underlying cause of the anxiety, but it will help put the brakes on it. Frankly, it’s useful for nearly any kind of clinically significant distress. And…

Anchors can also be useful for getting into a hypnotic state. Which is how we get to the Elman-Turner induction.

Elman and Turner
There was this hypnotherapist (and all around interesting character) named Dave Elman. He developed an induction -- a protocol for helping someone get into a hypnotic state -- that works pretty consistently and makes it pretty easy to go to different "levels" of trance state.

Then another hypnotherapist and student of his came along, Maureen Turner, and she added anchors to the induction, making it considerably easier to return different levels of trance state.

Voila. The Elman-Turner Induction was born!

I learned this process from Maureen Turner and find it immensely helpful for a variety of situations.

Why this is helpful
When I recommend we do the Elman Turner Induction to someone, it's for at least one of two reasons--usually both.

First reason: they could benefit from having more relaxation skills or inner resourcing.
Because of the anchor. Imagine you suddenly have the ability to tell your unconscious that it’s time to relax. And not just that, but you get to choose from one of four different levels/intensities of relaxation. I often like to use it with people who could benefit from having more control over their emotional state.

Second reason: they are coming to me because there's some deep hypnotic work they want to do: maybe deal with a phobia or work on some trauma, or something else that requires going deeper than might be easy to do in the average guided meditation or visualization.
The Elman-Turner Induction offers a relatively clear way to "go deep" and know where you are. It also makes it faster to get back to deep hypnotic states using the same anchors that allow it to be useful for self-hypnosis.

In practice, the Elman-Turner Induction involves me helping someone get into progressively deeper levels of therapeutic trance. I say me helping because I can't "make" anyone go into trance (hopefully that's clear by now?) But if someone wants to go there, I can help. So, I help someone go into progressively deeper levels of trance and then we do the anchoring.

Usually (as I mentioned above) we anchor/bookmark four states of progressively deeper relaxation, though depending on circumstances, we might do more or fewer. The basic four are relaxation states--the first one is a calm state, like sitting on your back porch or in your living room, or hanging out with a friend. The second one is a more deeply relaxed state, like being on a nice vacation or being out of school for the summer--not having anything you need to worry about. The third and fourth are even deeper levels of somatic relaxation.

Because therapeutic hypnosis involves deep relaxed states, the anchors can be used to aid with going into deep hypnotic states just as easily as they can be used for run-of-the-mill relaxation during the day or for falling as asleep at night. The four anchors correspond to Dave Elman's "map" of the levels of hypnotic trance state. While it can be very difficult to describe and pin down "levels of trance," Elman's map is a convenient and practical guide.

When I do the Elman-Turner induction with someone, I typically give them a "cheatsheet" afterward that explains what to do to "pull the anchors"--to use the bookmarks on their own. The anchors won't cure a problem, but they are a tool that’s very useful. Literally, it gives someone a tool to say, “relax 1 - calm” and feel that sense of calm. If you or someone you know has struggled with severe anxiety or another run-away unconscious process, you could probably see how this tool could be pretty life-changing. For serious issues (like the abovementioned phobias and trauma) this is a powerful first step.

After I do the Elman-Turner induction and the client comes back for a later session, we use the anchors as an induction— as a way to go into deep enough hypnotic trance to do whatever hypnotic work that the client and I have planned. While the Elman-Turner Induction we do the first time takes 30-40 minutes, using the anchors it only takes 5-10 minutes to return to the deep hypnotic state we got to the first time, letting us focus on hypnotherapy for the rest of the time.


More about anchoring

Sometimes people ask more about this anchoring stuff and how it works. The short of it is that anchoring is very common— common enough we don't pay attention to it most of the time. Say, for instance, you have a job (like I once did) where you have to answer an office phone. Over time, your mind learns that when the phone rings, you divert your attention from other things, maybe you modulate your voice so you sound professional, or even unconsciously reach for a message pad and a pen as you pick up the phone receiver. This is an anchor. Like a behavioral conditioning situation but with clear complex unconscious involvement, your unconscious knows that phone ringing means going into “answer the phone mode.”
Most anchors are set by repetition, including most of the stuff in NLP literature about setting anchors for good or bad. The only special thing about what we're doing here is that in deep hypnosis, anchors don't need repetition: we can set an anchor once and it's there whenever you want to use it.

Sometimes people are concerned that the anchors could be abused or create problems, as if they could give someone else control of your mind. This isn't the way they actually work because hypnosis isn't mind control. Also, I always do this in such a way that only you can pull your anchors, not anybody else. Even when we do it in session, it's you that's saying the cue to yourself.

Actually, the only danger is that the relaxation anchors can work too well, causing people to be too relaxed in situations that it's not a good idea, like driving a car or operating heavy machinery or a chainsaw. For this reason, I always tell people to avoid using the last two anchors unless they can rest with their eyes closed, and to avoid even using the first two if they're in a dangerous situation or one that requires strong alertness. Typically I’ll even include in the anchor-setting process suggestions that the anchors can only be called "when it's safe to do so."

In the next entries, I'll talk more about specific problems that someone might come and see me for and how hypnotherapy could help. First up: anxiety.

The types of hypnotherapy and my approach

Curious to learn more about hypnosis? Or about my approach to it? You’re in the right place. Read on…

Generally speaking, there are two schools of thought about how to do hypnotherapy. The approaches are sometimes called by different names, and really, it’s more of a spectrum between two extremes.

Directive approach

On one end of the spectrum is directive hypnotherapy, or sometimes called classic hypnotherapy or authoritarian hypnosis. In this school, a hypnotherapist gets a person into a trance state and gives the person's unconscious directions to make things better. Typically, this comes in the form of direct suggestions, a hypnosis term that refers to specific instructions that the unconscious will either accept or reject. Examples of direct suggestions are things like:

  • And now your legs will feel very heavy and you'll hardly be able to move them.

  • Now your body is more and more relaxed, as relaxed as you've ever been in your life.

  • When I count to three, you'll imagine yourself in the middle of Central Park.

Direct suggestions can also be post-hypnotic, meaning they can affect things after the hypnosis session is over. For example:

  • Whenever you see a pack of cigarettes, you'll become nauseous and filled with disgust.

  • When you notice yourself clenching your teeth, you will stop and it will feel like your mouth is full of soothing jello.

Most of the recordings and scripts you can find on the internet are primarily directive in nature, as are most of the books of scripts or manualized protocols you can find. What this approach tends to rely on is the authority of the person conducting the hypnosis to ensure that the person receiving the suggestions follows them. That is to say, when someone we respect or attribute authority toward (like, say, a doctor) tells us do something, we usually try to do it. And this is (mostly) even more true on an unconscious level.

In this directive approach, the suggestions themselves tend to be pretty straightforward and standardized: it's assumed that one method of weight loss or smoking cessation will work for everybody. While there are many other things that one can do in hypnosis besides make suggestions, it's much harder to standardize the other stuff.

Typically, if the hypnotherapist has significant enough authority or charisma and the problem isn't too complicated, this approach works really well.

I do this kind of hypnosis sometimes, but not very often. Why? Because while this works, people are individuals and giving the same suggestions to everybody isn’t as effective as tailoring something to each person individually.

Which brings us to the other approach:

The utilization approach

On the other end of the spectrum is the utilization approach. This approach originates from the work of Milton Erickson, one of the most important characters in they history of modern hypnosis, as well as of psychotherapy as a whole. Erickson felt that the utilization principle was his most important contribution to hypnosis, and it has deeply affected most of the field of clinical hypnosis, especially in the mental health world.

The utilization principle is the idea that the hypnotherapist uses the skills, material, and issues that the client comes with. In contrast to the directive approach, it's much more about crafting the right intervention for the particular person based on the person's strengths.

While the directive approach might be epitomized by the direct suggestion, the utilization approach is better epitomized by imagery or evocative techniques. What are those? Let’s imagine for a moment…

Imagine you have a good friend who is always watching out for you. In fact, your good friend is always with you and watches out for you all the time, often catching things that you miss, and thinking of the solutions you haven’t had the time or energy to think of.

Sounds great, right? Well, the good news is that this friend is your unconscious mind. Your unconscious mind is taking in all the sensory information that you aren’t consciously taking in, and is responsible for all the thoughts you’re not consciously aware of. For example:

The reason you woke up thinking about your 3rd grade teacher? Your unconscious was revisiting your those memories.

How you came up with a solution to a problem plaguing you at work while you were in the shower yesterday? Your unconscious was working on the problem while you were doing other stuff.

The reason you can’t help thinking of a elephant when I say don’t think about an elephant!? — your unconscious is helpfully responding to a suggestion (and the unconscious mind doesn’t typically recognize negator words, like don’t).

Typically, people don’t have strong relationship with their unconscious minds, or even have negative relationships with them. Nevertheless, the unconscious mind is there observing and thinking about things, gathering ideas and points of view. Evocative techniques or imagery techniques are ways to connect to the unconscious' vast pool of creative ideas andknowledge. Erickson is famous for saying things like, "Trust your unconscious: it knows more than you" and "You know more than you think you know." He’s speaking about that storehouse of knowledge we all have.

But, because this seems like it's getting abstract, I'm going to make up an example. Let's say someone contacts me—let’s call her Lynn, and she's dealing with anxiety regarding public speaking.

If I were to use a directive approach, maybe I'd see her for 1-2 sessions and give her a series of direct suggestions telling you that she will relax before she goes on stage or presents.

Again, this could work in many cases, especially if I present it authoritively and give Lynn the expectation that it'll work. The major pros of this approach is that it's fast and easy for me as a clinician. Two sessions is also not too expensive for Lynn and I would just do the same thing I do with everybody with a public speaking phobia. On the other hand, it might not work, or it could work for a bit and then wear off.

On the other hand, let's say I use this utilization approach. I meet with Lynn for a first session and I talk to her about her problem in depth. I know she has a problem with public speaking but I ask lots of questions about it and about her life in general. Here's a blurb of what I find:

Lynn, 39, works as a job rep at a temp agency. She enjoys her job interviewing people and trying to match them to prospective jobs. For reasons she doesn't understand, her boss has picked her to start doing group trainings and presentations to large companies who want to contract with her agency--which is great--except that whenever she gets in front of more than 3-4 people, she sweats heavily and has trouble modulating the loudness of her voice, sometimes speaking super loud, and sometimes very quietly, and it feels like everyone's giving her weird looks. She's motivated to get over this problem, though, because she likes her job and needs the money to support herself and her 1-year-old daughter. (She smiles a lot and looks blissful as she talks about her daughter, Becca)

In her off time, she reads a lot, mostly fiction, and makes references to books by Diane Wynne Jones. She also talks about cooking and baking, the fun of seeing how experimental recipes turn out.

When asked when the problem started, at first she says she's always had fear around group presentations, but notes that when she was in middle school, she did a presentation about nuclear power plants and, though she was nervous, it wasn't nearly as bad and she found she could speak fluidly and at length about the subject. She feels it was easy because she was knowledgeable about the topic at the time.

When asked about trauma and any difficult experiences, she indicates no abuse history or problems of that nature, but when talking about books she likes, she mentions her ex-boyfriend was just like Howl (from Howl's Moving Castle, a book by Diane Wynne Jones) and she once had a loud verbal fight with him in the middle of a pizza place when she was 16 because he felt he couldn't be seen in public eating bread sticks and was mortified that she was eating them without fear. While it's clear now that he needed a good bit of therapy himself, at the time, he demanded they leave and blamed her when the manager came to the table because they were "making a scene."

Now, I just made this case up. But you can see a lot in here that I can work with. In the utilization approach, it's my job to take this and craft a set of things to do to help from it. This process is collaborative and I’ll bring up any ideas before we do them. Some ideas that come to mind at the moment are: Maybe help Lynn connect to her love to her daughter before she presents--those chubby cheeks could go a long way to relaxing anyone. Or maybe could tell her a Diane Wynne Jones-esque story to indirectly suggest change, or evoke another character from her stories, like Sophie (a strong female character from Howl’s Moving Castle) who can help her get through those presentations. Likewise, she shows a sense of adventure and curiosity around cooking and such that could be helpful: What if we helped her unconscious draw a metaphorical connection between presenting and making an experimental recipe?: could that excitement and curiosity she feels while cooking replace anxiety. Or, Lynn and I could go back to when she was 12 and she was having a pretty normal reaction to public speaking and help her bring that feeling to the present. This is called an age regression and is a particular and special kind of evocative technique… or we could work with inner resourcing and self-appreciation in general, helping Lynn's unconscious learn the reasons her boss might think she's the right person for the job, and help her feel more like that right person. Or we could do another kind of age regression: go back to her 16 year old pizza restaurant incident and help her get free of any lasting effect that might have had on her unconscious--which, though not clinically traumatic, could be getting triggered, causing embarrassment to erupt from any situation people seem to be watching.

It's also possible to simply ask or evoke ways her unconscious might know to solve the problem, and work with those. Whatever we do, however I might prompt things, the solution actually comes from Lynn and what she brings.

In the end, this may take longer than a directive approach because I need to spend at least some time getting to know who the client is and what she brings. At least 3 sessions at minimum, usually 5 for a situation where I'm only seeing someone with a specific issue, like a phobia or a habit change. More sessions are needed, obviously, with issues where there is a need for both talk therapy and clinical hypnosis.

But the result of this kind of approach is much more nuanced than the directive method. Because it's so tailored to an individual client, and more palatable to an individual mind, it’s much more likely to be useful over the long term. Likewise, rather than coming from the authority of the hypnotherapist, the effectiveness of the utilization approach comes from what the client brings and how we (the client and myself) collaboratively and creatively work with it.

Actually, I apply this utilization approach to almost all my clinical work, not just in hypnosis but in therapy in general. Sometimes, I get the uncanny sense that I'm not actually the one doing much at all--that it's the unconscious of the person I'm working with that's responsible for healing and change, not me. When that happens, it's awe inspiring for both me and client. This is why I'm serious when I say that I enjoy helping people discover their strengths.

In the next set of entries, I’ll be talking about specific problems I address using hypnotherapy as well as specific techniques I use. First, I’ll talk about a technique called anchoring, and after that, anxiety.

What hypnotherapy isn't

Now that I've covered what hypnotherapy is, you're probably thinking about all the things I didn't touch on: how hypnosis is portrayed in movies and books and things you've heard or seen about hypnosis in general, or how your aunt Helen stopped smoking forever after 2 hours with some hypnotist in Brooklyn.

I'm going to cover some major myths about hypnosis.

Frankly, hypnosis has always had suffered from a problem of public image. Maybe this goes back to the origins of these sorts of techniques. I could guess why, but I'm not totally sure. Anyhow, without further ado:

Myth 1: the dominance/mind control myth

Many people think that hypnosis is somehow about a person (a hypnotist), gaining control over someone else's mind. For example, Incredibles 2 basically uses the term hypnosis as a synonym for mind control. And the recent movie, Get Out! (2017) is another good example of a portrayal of this myth in a more nuanced way. I've saved the spoilers/more full discussion for further below, but, long and short of it, in the movie, hypnosis is used basically as a restraint technique, keeping the main character from acting to save his own life. I've also seen portrayals of hypnosis being used to commit crimes: as if I could hypnotize a bank teller into willingly hand over the contents of their cash drawer without tripping the secret alarm.

In actuality, hypnosis is more complicated. Though based on some truth, and though hypnosis techniques are useful for many things, mental restraint and robbing banks are not among its uses, and it's definitely not mind control.

The truth here is that nobody can make you do what you truly don't want to do, even in a hypnotic trance state. The grain of truth to the myth, though, is that many of us are estranged from the wants of our unconscious minds. Sometimes, our unconscious wants to do things that surprise us.

This is how stage hypnosis functions: a stage hypnotist will attempt to hypnotize a whole audience of people. And it doesn't work on most of them. But, out of a group of 100, say 5 end of going into a trance and become the subject for a humorous set of suggestions and ridiculous antics. Why? Because on some level they wanted to. Maybe their unconscious minds wanted to know what it would be like? Or were bored with just sitting in the audience? or maybe they wanted attention or felt exhibitionist? Or because of their history with authority figures? Or doing so made them feel more in control than being a bystander? It depends on the person, who probably weren't aware what they unconsciously wanted themselves. But the result is that they might think that this hypnosis stuff is mind control.

Personally, I also think much of mind control reputation comes from authoritarian medical professionals and their use of hypnosis, especially in the last century. Back before ideas like collaborative treatment and before the internet, which encourages people think for themselves about their symptoms, the family doctor was seen as a major authority figure and source of wisdom. If he said you had chicken pox, you took that as a fact. If he said you needed to take this medicine every day for 3 weeks, you did it. If he said you needed an operation, you'd get it. The doctor's orders were—well—orders. And hypnotherapists (who were mostly doctors at the time) used this social power, usually rightly, but sometimes wrongly. So if the doctor said, "you're now going to go into a trance" your unconscious would have very little precedent to disagree. If the doctor told you then that your left hand would go completely numb, your unconscious would produce the numbness, or if he said you could enter a state of sleep so deep that a surgery could be done on you and you wouldn't wake, your unconscious would find a way to do it. (I use these examples because they're real: glove anesthesia and hypnosis-assisted surgery do actually happen).

So it’s not that hypnosis is mind control, it’s that for a long time, the doctors who practiced hypnosis were exploiting their authority to get people to do stuff—usually good stuff, though with a few noteable exceptions. Even today, most of us want to make authority figures happy, and our unconscious minds, wanting the same, comply with what authority wants.

On the other hand, it's unlikely that I (or any hypnotherapist I know) could get someone to do something that would cause obvious harm to themselves. Why? Because the unconscious (just like the conscious mind) wants safety, comfort and happiness, among other things. Even when it does stupid things, it wants these. Milton Erickson did a series of experiments with his students and patients about this. The results are amusing and quite telling. You can read about what he discovered here.

So could I create a posthypnotic suggestion that every time someone hears me stir a spoon in a teacup, they could consciousness, allowing me to lock them up and cut out their brain? Well, I haven't tried... but I’m confident that no, I couldn’t.

You’ll be happy to know, though, that authority has lost its prominence in clinical hypnosis. More about this in my next post.

Myth 2: the hypnosis = sleep myth

This is a complicated myth. I think sometimes this is evoked also to suggest mind control in the sense that when someone's asleep, they're vulnerable and it's as if someone else (again, the powerful/wicked hypnotist) can do all sorts of things to them they wouldn't normally allow.

On the other hand, hypnotherapists themselves perpetuate this myth in various ways. James Baird, an early pioneer in hypnosis sometimes called it “nervous sleep.” The term hypnosis itself is derived from Hypnos, the Greek god of sleep (Latin, Morpheus). Some inductions (techniques to put people into hypnotic trance) also involve the injuction to sleep.

If you're thinking about someone swinging a pocket watch saying, "you're getting very very sleepy..." then you've got the right idea: though I'd never use a pocket watch, the suggestion to sleep to someone who is definitely awake can produce a trance state. That said, I think this myth is more a culture/language issue than anything else:

We don't have a lot of good words for mind states in everyday English. We all know what it means to be awake, right? And we all know what it means to be asleep. But what about other states? Our language gets pretty vague…

"Lost in a day dream," "zoned out," "dissociated," "in a fugue state," "lost in thought"... All these are attempts to describe trance states--states that are out of the realm of "normal waking state." So are expressions like, "totally absorbed," "in the zone," “on a roll,” and “entranced”—the second set are descriptions of trance states that are useful or helpful in some way.

All the same, while you could easily tell me the difference between being awake and asleep, could you tell me the difference between being “zoned out” and “entranced”? Or how about “absorbed” and “lost in thought”? There’s no science to this at all.

The variety of trance states is immense--from ecstatic spiritual rapture to repetitious self-berating fantasy--and trance states are neither "normal waking state" nor sleep, but it's easy to see how, when we’re at a loss for words, people can make the logical jump from “well, I wasn’t awake” to “I was asleep” because we don’t have clear words for anything in between.

Myth 3: hypnosis is magical, effortless, and/or guaranteed to work

Sometimes people come to see me and they lie back and say declare something like, "okay! I'm ready! fix me!" as if I'm going to wave my magic wand, yell "Hazzah!" and their problems will fade away.

The other myths about hypnosis encourages this fantasy: the idea of a hypnotist controlling your mind can be relieving if you've been struggling to control your own mind. Likewise, the idea of going to sleep and waking up with your problem gone can feel very enticing if all you're exhausted from fighting things.

The marketing of hypnotists sometimes plays into this, as if the writer of the blog you're reading has all the keys to unlock your life. (Sorry to disappoint you: you have the keys—don’t let anyone tell you different. I promise to help you find them, though.)

There is truth the idea that a lot of amazing stuff can be done with hypnosis--stuff that can't be done using other methods. But that doesn't mean hypnosis is magical--it just means it's another approach that can do some stuff that other approaches can't do. Like all good techniques and tools, it can do some pretty amazing things, especially in the hands of the right person and in the right situation. But this isn't what makes it special--it's what makes it ordinary.

I've seen some astounding results from both pharmaceuticals and therapeutic massage, for instance. But they aren't magic and nobody would claim they were. They’re just each different approaches that can do things other appoaches can’t. Hypnotherapy is the same. These different approaches can also sometimes not work, or can even do harm. Like any ethical professional, I do my best to avoid doing harm, but there are no guarantees in any of these fields.

Despite hypnosis seeming otherworldly or "magical," I encourage people to be skeptical, thoughtful consumers of any kind of therapy, including hypnotherapy. If somebody is making incredible claims or seems untrustworthy, then don't take them at their word: do your research and ask more questions, or go find someone else. Avoid undergoing any treatment, including hypnosis, with someone you feel uncomfortable about. At best, it won't work. At worst, it could do more harm than good.

If you’re still reading this, you probably would like to know more about how I do clinical hypnosis. I will cover that in my next entry, “Types of hypnotherapy and my approach.


More about Get Out!

Above, I note that it's unlikely that hypnosis could actually do in real life what it does in the movie. I think hypnosis is a symbol in the movie to evoke authority and white people’s oppression/dominance over black people more broadly. What's represented should really give us more pause than hypnosis, which is just a symbol.

However, as I note above, there is an authoritarian bent to hypnosis that comes from the old school approach, which is what gives the symbolic representation force, and this is the grain of correctness in the incorrect portrayal in the firm. Race adds an interesting complication to hypnosis and the authoritarian model.

If we just look at the portrayal of hypnosis in the movie, essentially the question becomes: could the power of racial authority be strong enough to induce black people to let themselves be destroyed by an authoritative white person? I say it’s really really unlikely. If it were the case, though, hypnosis then would simply be a tool/weapon used in a bigger cultural problem of internalized racism or internalized racial authority. Though I'm an expert in hypnosis, that greater cultural problem is not something I can speak to with expertise. Likewise, my expertise in hypnosis itself is to help people do the opposite with the tool than what was done in the movie.

That said, what I know about real life mind control research is this: the hardest part of controlling anybody is the problem of getting them to do something they really on the whole don't want to do. The attempts I've read about to do this have required torture, obscuring reality with drugs, subverting people's beliefs with propaganda, and other work-arounds simply to get enough of a person in line with the desired action. Much of this is quite ugly (think Reek in Game of Thrones) or (in the “best” cases) very time consuming.

If anybody developed a clean, easy mind control strategy to do what Missy Armitage does in the movie, it would be a momentous (and catastrophic) development, which would be infinitely more profitable in the military world than any surgical technique to replace people's brains. In other words, a more realistic portrayal of this in the movie would have the whole family supporting Dr Missy Armitage (Catherine Keener’s character) as she sells her services to clandestine military operations everywhere to create secret agents that can be activated at the stir of a spoon.

What is hypnotherapy?

Have you wondered about hypnosis but didn't know how to ask about it?

Been afraid or curious about hypnosis but don't really understand it?

Aren't sure if hypnotherapy is for you?

Well, I've decided to do a blog series about my hypnotherapy work. This is the first blog entry, a basic answer to the question:

What is hypnotherapy?

Hypnotherapy is the therapeutic use of hypnosis. Basically, I use hypnosis to help people with psychological problems. Hypnosis itself has been around for hundreds of years, and much longer if you could all the stuff that existed before the name hypnosis came onto the scene.

Basically, as a therapist, I help people enter, exit, and utilize trance states for psychotherapeutic purposes.

A trance state is an altered state of consciousness where you're focused in a particular way, often at the exclusion of other things. This may sound unusual, but it’s something we all do every day:

Maybe you've been watching a show, playing a game, or reading a book at some point, and been so absorbed that you've lost track of time, or things were happening around you and you didn't notice.

Or maybe you've had the experience of driving or walking somewhere and realize you've arrived and have no recollection of the journey because you've been so involved in your thoughts.

Or maybe you've meditated and it felt like you entered a different world in some way--that things were suddenly different... In all these situations (and in hypnosis), your mind is engaged in a way that it isn't in normal life--this is what an altered state means--and it's focused in a particular way.

Though these experiences are all quite different in nature and in purpose, they're all trance states.

In clinical hypnosis, the purpose, just like in psychotherapy in general, is psychological benefit.

What we are able to do with trance states is pretty impressive: people go into "the zone" and they write books, play music, create beautiful works of art, and come up with life changing solutions to problems.

What can happen in hypnosis can be impressive too. I regularly help people learn how to give their unconscious the message that it's time to relax or go into a different mode. And I regularly work with people to let go of past traumatic experiences or fears. I also help people learn how to connect to their unconscious abilities or knowledge in fascinating ways. Sometimes, the results of these ways utilizing trance states come quite quickly--much more quickly than in talk therapy.

You may have the idea that in hypnosis, someone puts ideas in your head, like, “from now on, when you see a cigarette, you’ll feel nauseous.” This is what’s called a direct suggestion. I’ll talk more about this later in my blog series. For now, you should know, this is only a small part of what hypnosis actually is.

On the other hand, if you've seen hypnosis in movies--for instance, the recent movie Get Out!--you may have an impression that hypnosis is something like mind control. This is a misconception.

Likewise, if you've seen stage hypnosis performances--it's also not like that at all. (stage hypnosis is definitely not therapeutic).

I'll cover more about hypnosis myths in this blog series’ next installment: "What hypnotherapy Isn't."

Confidentiality and the unique nature of the psychotherapeutic relationship

Psychotherapists are treating more or less like any kind of health professional when it comes to confidentiality. Just like your doctor is not supposed to go talking to her friends about your health problems, a psychotherapist is not supposed to go talking about your mental health. What this means practically is something that you (hopefully) already know:

psychotherapy is confidential, meaning nearly everything that is said in my office is kept secret.

There are a few exceptions:

  • If someone tells me that he/she is going to kill himself or another person, I have to take action to stop it. Usually this means calling the police or local psych emergency services.
  • If someone tells me about a case of child (or elder) abuse, I also have to report that to the state department of child protection and/or the police.
  • If I'm subpoenaed by a court or being investigated by an oversight agency, this might result in some confidential information being shared (depending on the nature of the investigation/case)
  • If you give me written permission to talk to specific people or organizations.

This last case is the cause for the vast majority of my disclosures of information as a therapist. For instance, I need to give certain information (billing codes, sometimes summaries of treatment or my notes) to insurance companies in order for them to pay for therapy on your behalf. If you come to see me and use insurance to pay for therapy, you sign a form that gives me permission to give this information.

When it's to your benefit, I may also get your written permission collaborate with your other health care providers. The idea that it's for your benefit is important: even if you give someone permission to share your protected health information, the idea is that it's not gossip or for their amusement. Sometimes the ethics of information sharing for the client's benefit is straightforward--say I call a psychiatrist because some medicine she put our mutual client on doesn't seem to help. Pretty straightforward. But it's not always so clear. While your primary care doctor and your cardiologist might have no qualms about sharing information, therapists often do have qualms, especially with providers who aren't mental health professionals.

The question is like this: how much does your cardiologist really need to know about your mental health, even if it's impacting your heart? Another way of looking at it is like this: Client-therapist relationships are typically highly privileged, meaning there's stuff you'd tell a therapist you wouldn't tell your PCP or your podiatrist. If your therapist turns around and tells them, it could feel quite violating. So even though professionals are given a lot of leeway about talking to other healthcare professionals, and even though you probably signed a piece of paperwork at your first doctor's visit that gives them permission to talk to anybody they need to in order to facilitate your care, a typical therapist will get formal and explicit written permission to talk to another of your health care providers. This protects the exceptional nature of the therapeutic relationship, makes sure you know about and are okay with any disclosures of information, and protects the psychotherapist legally.

Likewise, if you give written permission--typically if you complete and sign a form usually entitled "permission to release protected health information," a therapist  can talk to someone else--maybe a family member or a friend--about what's happening.  Usually I make sure I know exactly what information is okay to give and not give. Again: client-therapist relationships are usually unique and should be protected.

Another important note or two: If the client is under 18, parents also can get information about treatment of their child. I don't usually see clients under 16 or so, but if I'm working with an adolescent I make sure to talk to the parents specifically about what information they will want so that the rules are clear. Just like anyone, a 17 year old is not going to feel very comfortable talking about certain things (for instance, her mother) if she knows that her mother is going to get the scoop from the therapist.

These rules have some other broad implications:

Even the identity of my clients is protected. So if someone calls me and wants to know if her brother has been seeing me for therapy, I have to say that I'm not allowed to tell the caller.

Likewise, if two of my clients know one another, I can't tell either of them that I'm seeing the other. That said: I can and will ethically refuse to see a new client if I'm seeing someone close to him/her and it would get weird, but I have to give a vague reason (like "I can't see you for ethical reasons" or "I can't give more information, but I think we know people in common and it would get weird.")
After the recent election, someone asked me if Mitch McConnell is one of my clients. Why he asked this, I have no idea, especially since Senator McConnell is from Kentucky and works in Washington DC, while I live and work in Massachusetts but--as you might guess, I had to ethically respond, "I can neither confirm nor deny the identities of any of my clients."

In the normal course of things, it also means that if I bump into a client at the grocery store or in downtown Northampton (or any public setting), I can't reveal in any way that I see him or her for therapy unless given some kind of permission to do so. Usually this means (for simplicity) that I don't acknowledge the person at all unless the person acknowledges me first. In short, I follow their lead: if a client waves and says hi, I assume that it's okay if I do the same. If someone introduces me to her friend, I assume it's okay for me to acknowledge whatever she's said.

Again, this is about the nature of the client-therapist relationship. A lot of stuff can happen in my office. It's comforting for most people to know that, even though I'm a person who leaves my office and buys groceries or parks in the lot behind Thornes Market, what they talk about (and even that they were in my office in the first place) doesn't get shared unless they're okay with it.
Sometimes when I explain this to new clients, they'll say, "well, it's fine with me if you come up to me in public." This may be true, but it's hard to tell: I explain that they might feel different if they were around specific people--a new romantic interest or people from work. Or, after we get into the midst of therapy, they might feel differently no matter who they're around. I always point out that if they want to acknowledge me and talk to me in the moment, they can also do that, but I'm not going to make any assumptions.

I should also note: clients can do whatever they want in terms of confidentiality. The rules and guidelines govern me, not them. I will, as noted above, follow their lead. I have certainly had clients who happily come up to me in public and want to talk, or even tell the people they're with (or the people that I'm with) that I'm their therapist and how great I am. And, my own modesty aside, that's also fine.

Other therapists will have other rules and different ways of handling situations, but we all follow generally these same guidelines.  Actually, (nearly) every healthcare provider follows these guidelines. But psychotherapists, by in large, take these guidelines very seriously because of the nature of our work. Sometimes this is criticized, especially as managed care moves psychotherapists into doing more cognitive and short term work. This presumes that because healthcare is becoming faster paced and less thorough, that therapy should too. Even if therapy as a whole moves in this direction, it presumes that the unique nature of the client-therapist relationship can be cast aside. Granted, everything in this world needs to be able to change and adapt, including the institutions of psychotherapy. But psychotherapists aren't primary care doctors. It is a different science and art. And I think people will always think of us as such, and relate to us differently. So I think its uniqueness should be respected, and do my best to do so.


Yoga nidra as a home practice

Imagine a scenario with me:

Imagine you go to see a psychotherapist and decide to work with him to help you with some issues you've been facing in your emotional life and relationships for a while. You feel stuck and everything you try doesn't seem to help. After explaining all this and talking about a lot of different things during the first session, the therapist brings up the idea of homework.

After imagining worksheets or something boring, you're pleasantly surprised when he brings up doing a daily meditation practice designed for just the kind of issues you're having. He says takes about half an hour to do every day. You haven't meditated before and aren't sure you can do it and say so. He reassures you, "This is a very easy practice. Just listen to this recording once a day and follow along with the instructions. I think you'll enjoy it actually." He also explains that this isn't the sort of meditation that requires sitting on the floor or doing anything particularly special. In fact, traditionally it's done lying down, like at the end of a yoga class. He adds that it's optional; you can try it and not continue if doesn't work for you.

In the end, you're impressed at his conviction that both the meditation and the psychotherapy will help your problem from different directions--that they'll work synergistically to help you resolve your problems more quickly and easily. He also indicates that the meditation will help with your sleep (which has been a problem off and on) and help you to unwind from stress.

After you get home, you decide to try it. The therapist has emailed you an mp3 which you conveniently cue up that evening. You do find it relaxing. In fact, you fall asleep. But over the next week, you find you enjoy making the meditation part of your routine, and find you only fall asleep when you're utterly exhausted from the day.

The next time you see the therapist, he explains that falling asleep is the biggest "side effect" of the meditation and not to worry. Even when you're asleep, he says, the meditation does some good. And probably you needed the sleep. You have a good session with him and are beginning to feel a bit better, even though it's only been a little over a week.

As time passes, doing the meditation feels quite natural. You discover you can be deeply relaxed when you do the meditation and still be aware of what's happening, and you actually fall asleep rarely. You find this relaxation and sense of awareness slowly carries over into your daily life:

Things that normally catch you  or bother you up seem more matter-of-fact. You  feel as if you're making different choices about how to respond to your life. This leads you to change some significantly things in your life--things you've thought maybe you should change for a while but now have the perspective and will to do something about. A quirky physical issue you didn't know was related to your level of stress starts to improve. You find working with the therapist insightful and gives you another way of looking at your relationships and the patterns of your life up to this point.

Over time, it feels like your life has gone from riding white knuckled in a canoe down rapids to gliding along on a beautiful mountain lake. It's not clear exactly why things have changed, but they definitely have.


As you might guess from the title of this blog entry, the meditation in this scenario is a practice called Yoga Nidra. Despite its Sanskrit name, this practice is very accessible and is designed for modern times. In the 1940s and 1950s, a Swami named Satyananda Saraswati created this meditation style, adapting it from much more complex and esoteric Hindu practices that were available at the time. It has continued to evolve and be modified by other meditation teachers since then. There are actually many varieties of yoga nidra now, including those taught by the Bihar yoga school (which Satyananda founded), a form adopted for working with trauma and anxiety called iRest, and types adapted by other schools of yoga, and various yoga teachers all over the world. In its current form(s), yoga nidra has pieces that are similar to mindfulness meditation (especially the body scan and mindfulness of breath--two of the most common mindfulness practices), and also has elements that are like hypnosis or guided imagery. There are other elements that are similar to Hindu or Buddhist tantra, and there are elements that are unique.

The best general description I can give is that it's a guided deep relaxation practice that's made up of smaller practices that all work together, like a well-formulated multi-vitamin or a Chinese patent medicine. The practice is non-dogmatic, requiring no spiritual experience or beliefs, and is very straightforward to do.

As a psychotherapist, I have been attracted to yoga nidra because it is so compact and easy: A lot can happen in the 30-45 minutes it takes to do yoga nidra. It's not a big time commitment for someone with a busy life, is easy to do, and the effects are good.

It is also infinitely adaptable. Meditations can be tailored for specific goals or to solve specific problems, and with specific people in mind: I have been working, for instance, on yoga nidra recordings that are suited to help with common problems that bring people into therapy. You can get one of these practices here if you join my e-mail list (which, at the time of this writing, will send you notifications of when I write more blog articles).

Based on my study of yoga nidra, hypnosis, traditional medicines, mindfulness, and related psychological models, I've also started designing yoga nidra practices especially for certain people or groups of people. This really is akin to formulating a Chinese or Tibetan herbal formula that treats a specific condition in a specific person with few (if any) side effects. If you know anything about Chinese herbal medicine, you know this can be quite a spectacular thing.

This personalization is also relatively rare: Although Swami Satyananada would do this, most yoga nidra is taught in yoga studios and/or is based on general scripts. If you attend an open yoga nidra class, you'll get a very general experience. Although these general experiences can themselves be therapeutic--deeply relaxing, meditative, spiritually relevant, mindful experiences--they're only a part of what is possible.

That said, this practice is not magical. I hope nobody reads my scenario and sees anything supernatural or unrealistic: therapy (and beneficial change in general) is still work. And I would still recommend having a therapist to work with in concert with using a home practice like yoga nidra if using it as part of a treatment. Yoga nidra is also not a replacement for other meditation practices. I continue to recommend loving kindness or mindfulness practices instead if those are what are what would be of most benefit. My intention is simply to convey that this is a great tool.

Are you interested in trying it? Contact me or feel free to download an mp3.


How to make your therapy go further...

Dear readers,

My apologies for blog radio silence for a few months. I've been having a period of reading rather than writing, learning rather than teaching--of taking in rather than putting stuff out there.

I've been researching primarily based on a question that has become a major area of interest for me: what kinds of activities or practices best augment psychotherapy? One very straightforward way of expressing the question I've been asking is:
Someone comes to therapy and spends money on it. What can a person do in between these 1-hour-a-week sessions to get the most benefit from that hour?
Or even more straightforward:
What can I tell my clients to do to make therapy work better?
Or really bluntly:
How can I make sure clients are getting the most for their money?

There are some great classic answers to these questions... Here are a few:

Contemplation and Creative Expression

For a long time, it's been clear to therapists like me that pursuits like art, writing, talking about personal stuff with warm friends and other forms of introspection, self-reflexion and self-expression help. What works best depends on the person. Some people draw or paint. Others write. Journaling is great. I often even just encourage people to have a white board they write things they're thinking, their goals, dreams, ideas. In a busy world, this helps a person focus on what's really important.


Likewise, research suggests that for mild to moderate depression and anxiety, different forms of physical exercise may actually be the most effective intervention. Oriental medicine chimes in that moderation is key.


Likewise, In some cases, taking a good medication is an indispensable adjunct to therapy: if someone is in such rough shape that they can't focus during therapy sessions or can't look at what's happening easily, therapy won't go far. It's like trying to have an important conversation with loud music on: first thing to do is turn down the music. Of course--in my view anyway, the long term idea is to eliminate (or at least significantly reduce) medication. 


Sometimes I will recommend a book. This can work in a number of different ways. The most straightforward way is that I might recommend a book that talks about some of the issues we're talking about in therapy, or which connects to a technique we're using. I recommend some books on my website. Feel free to check them out.
Sometimes, I'll also recommend a book that's less straightforward. For instance, I might recommend a fiction book or a book of essays. When I do this, I'm usually thinking about a client's need for a certain kind of psychological nourishment. If this sounds woo-woo, you should take it literally instead of figuratively: just like our bodies need good food, so do our minds. A good story provides nourishment. Put another way, reading a story can make someone feel less alone, or it can give someone strength, or even provide a map for how things could work out. This is necessary sometimes. Just like a person needs good food to heal from a physical injury or in order to gain muscle, a person needs good psychological food to recover from a psychological injury or to grow strong psychologically. Actually: good (physical) food helps a lot too.

Continuing the session...

There are also some more subtle things: one of my favorite therapists and I would often talk about the process of internalizing one's therapist. Or as I sometimes frame it to my clients: "even though you have to leave my office, you should take me home and continue therapy by yourself. Think about what we've talked about. Continuing talking.  Imagine me responding. Then, when you come back, tell me about our conversations."

What this really speaks to, of course, is something we all do: we rehearse and imagine conversations with people. If you have a skilled therapist that you like, no matter what kind of therapy you're doing, you'll probably find yourself doing this.

Rather than proof of some kind of psychotic process, this is a good thing (as long as you're aware your therapist isn't actually in your head). What you're really doing is continuing the session. When you come back and talk about your conversations (as I suggest) you're honing your internal imagine.

Effectively you're crafting your own internal therapist--one not limited to a regimented hourly schedule. And isn't what anyone who felt alone with a world of hurt has always wanted?--someone with wisdom and caring closer than their own nose?

More soon...

One of my major interests, of course, is meditation and other mental practices as an adjunct to therapy. I've studied mindfulness based approaches in great depth over the years. Likewise, of course, loving kindness (metta) practice, after which this blog is named. There are (of course) other practices.  I will write more about some soon. 

about depression...

After my last post about the autumn, a lot of questions about depression have been coming up. Naturally, people are curious what they can do about seasonal depression, and likewise about their mood in general. 

It's late winter now--we're past the new year and most people's enthusiasm for cold and dark seems to wane sometime around this point. A colleague of mine recently thoughtfully noted to me though that we're actually past the worst part: the solstice--Dec 22nd--is the longest night. We're on our way out now. If you're dealing with seasonal depression, keep this in mind. It will be coming to an end soon. 

Different people experience seasonal depression differently: for some the worst part is the fall. For others, it's the mid-winter darkness. For yet others, it's the sheer longevity of winter or the contrast between the urge to nest and the demands of work and life. Whatever your experience, remember to be kind to yourself. Vitamin D supplements, light therapy, and being around warm people all will help. But something easily overlooked is curiosity about your experience: it's very easy to jump into a mode of fixing things. When it comes to the mind, fixing things doesn't always work. 

More about depression in general...

The most important take home message about depression: 

If you're dealing with depression, you're not alone. Depression is very common. A BBC News article came out last November about the global impact of depression. Depression, is, perhaps surprisingly, a global issue. 
I say "perhaps surprisingly" because a common feature of depression is a feeling of aloneness, alienation, or lack of support or understanding from others. It can be hard to believe others feel exactly the same. Other common symptoms are hopelessness, self-blame, feelings things will just continue like this forever (remember what I said? winter is going to come to an end), lethargy, poor (or over-active) sleep, changes in appetite, certain kinds of obsession, and (in some cases) suicidal thoughts.  Culturally we also tend to sweep depression under the rug, which can add feelings of shame and the need to hide. In truth, these feelings are symptoms, you might say, of something all-too-common. 

It didn't always used to be so common. We don't know why, but depression has increased significantly over the last century. Nobody (as far as I know?) clearly understands why. Perhaps it's something to do with modern lifestyles? Or with lack of community? Other changes in social structures? The industrial revolution?... There are many theories.

In contrast, I talk to many people who understand depression (and most mood problems) as the result of a chemical imbalance. Usually people are referring to the theory that mood is tied to serotonin levels in certain parts of the brain. SSRIs (Serotonin Synaptic Re-uptake Inhibitors) work based on this theory... Though, truthfully, at this point, nobody is sure how exactly neurotransmitters, especially in relationship to one another and to experience.

One very important thing to remember is that brain chemistry (in whatever form) is not a one way street. Often, when someone tells me he or she has a "chemical imbalance" it's a way of saying, "It's not my fault I feel this way--it's biological!" On the one hand, I agree with the sentiment of blamelessness: it's not going to help to say it's your fault you're depressed. Remember self-blame is a symptom of depression (I listed it above)--getting mired in self-blame usually worsens the depression. On the other hand, when someone says his or her depression is biological, it's usually a way of saying nothing can be done about it except a pill.

In a perfect world where antidepressants worked like antibiotics or athletes feet creme, that would be fine: you could say, "it's a biological problem!," take a pill, and be better. But depression isn't like that. Antidepressant medications, when they work, may address a chemical imbalance, but they re-balance it only temporarily. Don't get me wrong--antidepressants can be great tools on the path of recovery, but the real work of depression is to change brain chemistry by changing how one thinks. 

This isn't as hard as you might imagine. We've actually been changing our brains for thousands of years. It seems that that's what our brains are actually built for. We used to think that people would learn stuff and their brains would change until they hit their mid-thirties and then their brains would start dying and it was all downhill from there. We know now that this is very far from the truth. In fact, neuroscientists have been noticing how much what we do with our minds changes our brains. A great layperson's book about this is The Brain That Changes Itself by Norman Doidge. In both classical Buddhist thought and in Cognitive Behavioral Therapy, the idea that thought creates mood (and even one's experience of reality) is well established, and both traditions contain powerful techniques for changing how one thinks. Happily, psychotherapists (at least ones like me) are learning from both of these lineages.

If you're looking for a practical take-away, remember how I started: first to remind yourself that you're not alone. Get yourself whatever kind of help you need: see a therapist, a psychiatrist, or your doctor and talk to warm friends. If you're noticing suicidal thoughts, utilize lifeline or contact emergency services for your area (link is for Western MA). Like my colleague pointed out, the darkness will come to an end.


Fall, depression, grief, and abundance

Fall can be a rough time for people. There are lots of interesting studies and anecdotal evidence about winter being a time when people deal with Season Affective Disorder (a term used as a fancy name for seasonal depression, usually). I think Fall sometimes gets under-considered compared to winter in New England. Of course, what season can compete with winter in New England? But I've been talking to a lot of people struggling with their mood this fall, so I wanted to discuss it.

It's late fall now.

In the hills where I live, it's frosted a few times, the time change has happened, and the leaves are all gone. I think of Fall as having two distinct phases: early fall, when the leaves are changing and it's windy and crisp--there's the sense of things coming--things happening.

And then late fall, when it's certain that winter is on it's way, the leaves are gone (or at least thoroughly brown) and the air, though still crisp with the sense of coming winter, isn't charged in quite the same way. One can, I think, feel that the energy of life is retreating, moving away from the exposed natural world deeper into the ground, into our bodies, and into our houses.

Traditionally in Chinese Medicine, fall is associated with grief. I think grief is an interesting idea to contemplate. One way of thinking about grief is in terms of what's happened over the course of the year: Summer is the time for play, opportunity, and possibility.

When fall really gets into swing, and the energy of life starts moving inward, this can trigger a sense of grief for what's being lost, and also for what's been missed: the opportunities not taken, the possibilities not explored.

A basic rule of psychology is association:

One feeling of grief or regret can remind you of another--griefs and regrets forgotten can resurface again because of the grief of the season.  The very blowing of the wind through the brown leaves can trigger this feeling. But it can also be more subtle. Even if you're not watching the turn of the season, there's something about the quality of the air that can bring up all sorts of grief and regret. An acupuncturist friend of mine says he can see fall in how people hunch their shoulders. Even if they aren't aware of it, he says, he can see the inward movement in their postures.

In my office, I see fall as trouble sleeping, thinking about things from the past, people evaluating their lives, and people experiencing strong grief or regret about the paths they've taken and not taken. Sometimes this arises in small ways: the vacations they took or not or the summer. Sometimes in large ways: how they've lived their lives or the choices they make 15 or 30 years ago that still affect them now. This is the energy of fall.

If you have many regrets, or are simply sensitive to the nature of things, this can take a lot out of you.

Many people I talk to have trouble keeping up the fast pace of their lives with this sort of inward movement of retreat and grief going on. Usually, I suggest people give themselves a break if they can: the fast pace of our lives these days is not so great for us in any case. So if you can slow down a little (not stop entirely, mind you, but slow down) and feel the pangs of the loss of the warmth in the world, or the loss of some aspect of your life you never lived, do so.

Like all feelings and seasons, the grief will pass. Actually, depression this time of year is the result of trying to clamp things down--trying not to feel the grief and regret, or trying to avoid it at all costs. Chinese medicine would say that this does much harm to our systems--tensing your systems when they should be naturally preparing for what comes next, winter.

Other specific recommendations from my experience and from Chinese medicine are as follows:

  • Move your sleep cycle earlier
    Use the fall time change (fall back!) as an opportunity to go to bed earlier and then get up a bit earlier. The autumn mind is often clearer in the morning, and fall morning air is supposed to be good this time of year to prepare the immune system. Likewise, if you have any tendency toward being a "morning person", you'll be able to use the little extra time in the morning to slow down a bit and prepare--pull out your scarves and hats from the closet--or to at least treat yourself kindly by eating a good breakfast and thinking about your day.
  • Consider not just the regrets and grief but also the joys
    Our minds have a fascinating tendency to look at what's gone wrong. That's alright. But while you're thinking about regrets, consider also what has gone well. If you can't think of anything, look a little deeper. There's no story without at least moments of spring.
  • Welcome the “return of the dead” (a real Halloween)
    Sometimes I think that Halloween was a wonderful idea crafted by smart people who wanted to give people a way to acknowledge the way the past resurges as late fall arrives. Metaphorically, the dead return. Same idea I've been talking about, right? Our modern Halloween is not so contemplative and usually involves dressing up and gorging on sweets (or beer) instead.
    If you can, take a few moments (whether at the end of October or some other time this fall) and acknowledge the dead, so to speak. I often will use the kitsch of Halloween to remind me: I'll look at the costumes and the lawn decor and I'll say to myself something like, "Fall is really here" and let the what comes up come up.
  • Celebrate abundance, the other aspect of fall
    Just like Halloween seems like it could have been invented by brilliant people, Thanksgiving seems like it could be a great opportunity to make the transition into early winter: you've reconciled with regrets and now you're looking at the abundance of what the season has left you: food, friends, family. If you can sort through your feelings and you have the outward circumstances to have such a meaningful thanksgiving, great! More often than not, in my experience, this is not a typical thanksgiving experience. Instead, thanksgiving can highlight the opposite: what's gone wrong, crazy families, regrets, lack. Typically we deal with some performance of family and then retreat into the consumerism and glitz of the holiday season. Sometimes, when I know someone is about to embark on terrible holiday season, I encourage them to make predictions and lists of everything that will come up and go wrong: all the family antics, all the problems and petty arguments or dynamics that will come up. You can try this too: write down everything bad you expect to happen. After doing this, people sometimes also notice the good things (or at least find the humor in the bad things). If you have friends in the same boat, you can also make a game out of it by seeing how accurate the list is: as the holidays happen, check things off. You can see who got the most "points." Then you can have a real thanksgiving (or Christmas or whatever) in which you celebrate your friendship.

Being aware of abundance in this way is great preparation for the winter. Winter, according to Chinese medicine, can give people feelings of anxiety and lacking. Western psychology considers this to be where the real seasonal mood issues set in. You'll do best if you can come into winter with eyes open, focusing on what you've got.




Home Practice?

I want to write today about home practices.

Home practices are "homework" I give as an adjunct to therapy to make therapy more effective.

I would say "to make therapy more efficient" but efficiency is a tricky idea especially when it comes to mental health: sometimes things change fast and sometimes slowly when it comes to mind. So efficient mental health care is elusive. But effective therapy--therapy you can look back on and say, "I got something out of that!"--that peaks my interest and is something I've been studying and thinking about for a few years now.

In a nutshell, home practices are activities, exercises or guided meditations I recommend people do when not in the office with me. One premise of this is simply that one hour a week (on average) of meeting with a therapist, though helpful, is not that much time. Anything that bolsters it is a good thing. 

I've been particularly interested in meditation practices that augment therapy.

There have been a number of studies over the last 20 years that document meditation's helpfulness when working with particular mental health issues. In certain cases, such as with Mindfulness Based Stress Reduction, an eight week course that utilizes mindfulness meditations as part of a program to manage stress and promote well being, the results have been quite dramatic.

The exploration of home practices has really just begin, though. The MBSR program, as amazing as it is, only uses a small portion of the array of mindfulness practices that exist. There are a number of others out there that are also potentially helpful.

Even the realm of mindfulness meditations is restrictive: though certainly a kind of "gold standard" for mental health promoting meditations, these meditations aren't the only type of helpful meditation out there. It's worth noting that just because one particular style or category of meditation helps one person, it doesn't mean it will help another.

The application of mindfulness to every mental health problem is like taking tylenol for every kind of physical illness. Though no one would argue that tylenol isn't helpful, it's not going to help everything. Traditionally, different practices are given to different types of people based on temperament and problems. As we learn about meditation in the West and apply it to our problems and our ways of understanding, we're learning how to do this.

Along with mindfulness practices, I've also been particularly interested in compassion practices (another heavily studied grouping of Buddhist meditations), and in what I call hypnoyogic practices--yoga nidra and forms of guided imagery--for their usefulness in augmenting therapy. All three of these groups of practices are forms of practice that are part of ancient understandings of how to work with the mind. 

What I've noticed is that people who have been willing to embark on the adventure of some of these practices are finding their therapy more effective. When I've discussed these practices with other therapists, I've gotten similar reports: those who do and stick with the proper practice do get results. 

You may notice I stuck the word "proper" in there. Really, this just goes back to the tylenol metaphor: what works for one person with a particular problem won't necessarily work for another person with another type of problem. I used to think that doing any kind of meditation practice was better than doing no practice. And (and not to contradict myself entirely), there is truth to that notion.  But there definitely cases where an expert is handy. I think anything where a clinically significant mental health issue is at play is a situation where it's best to consult an expert.

Of course, personal preference (and a host of other factors) also should be noted here.

Some people, for whatever reason, do not want me to give them home practices. This is okay. Therapy on its own is also a powerful practice for working with the mind. (If it weren't, I wouldn't be in this field.) Some people also have trouble making time in their schedules or find it difficult to take the risk on these sorts of adjunctive practices. This is also understandable.

That said, meditation isn't just about sitting on a cushion. Back to my old favorite, loving kindness (metta) practices: after you know how to do it, I think metta is just (if not more effective) to do out in the world: while driving, walking, shopping at the grocery store or waiting for a bus. Give it a try. It doesn't take any extra time--you just do it while going about your day. 



The new blog...

When I first began my private practice in Northampton, I started a blog. As things started getting busier and I started having some technical problems with blogspot, I reluctantly abandoned the project. But given the new things I've been doing and the kind of work I've been developing, it seems like the time to reinvigorate it. I named the old blog "The Metta Project" and wrote a post long ago about how that name originated. I'll share it with you now.

The Metta Project?

Metta is a state of mind that's intimately connected with mindfulness. Traditionally, it's said that mindfulness-awareness and metta are two wings of a bird. You need both to be a whole bird, and to be able to fly.

Metta the word translates roughly to something like "loving-kindness" or "loving-friendliness" in English. It's like compassion, and is related to all positive inter- and intrapersonal feelings.

In a nutshell, it's the feeling of unconditional love--or the kind of caring you'd give to your closest friend... It's the feeling you have for people you care deeply for and that you (ideally) have for yourself. Traditionally, it's also described as the feeling a "mother has for her only child"--although that might confuse the issue more than clarify it, depending on your mother. I think, though, that it's a good reference if you are a mother or father--it's that heart feeling of willingness to suffer and exert oneself for the sake of someone precious--that you often feel for your kids.

Metta is a lost art in some ways--especially when it comes to caring about oneself. Loving oneself is where it all starts: you can't love others without loving yourself. Unfortunately, most people lose track of themselves as deserving of love in the midst of all the messages we get about being better, and about acquiring the external things we're told we need, trying to acquire love and trying to change ourselves to get what we want out of life.

As a psychotherapist, I see the lack of metta and its effects pretty starkly. I'd say that the problem of 90% of the people I see in my work--and I'm not exaggerating here--is caused by an inability to love oneself for who one really is.

Wrap your mind around this. 90%. Of clients over my professional life. Addiction, depression, schizophrenia. People who can't accept and love themselves (and then can't accept others)--can't "say yes" to their own being, like in the guided meditation I posted.

The Buddha says this even better than I do... There's a scripture in which he lists a bunch of profound and righteous actions that people can do in order to develop good karma.

(Note, if you dislike about hearing about the Buddha and karma--you can pretty much substitute "a really great therapist" for the Buddha and "psychological health" for "good karma" and you'll still have the story.)

He lists a bunch of great things people can do... Stuff like feeding and clothing people--especially holy people--and supporting people who're trying to cultivate their minds. Everyone's delighting at knowing that if they give food and their possessions to holy men, they'll be happy and healthy. Seems pretty cut and dry. I can imagine people packing up to go home, pretty clear that they get the message. And then he says:

As great as all of these might be, it would be even more fruitful to develop metta even for the time it takes to squeeze the utter of a cow.  [AN 9:20]

I'm dramatizing a bit here--but I can just imagine people wrinkling their brows and looking around, confused: Weren't they supposed to give everything they owned to the Buddha? What's this about loving kindness?... It takes maybe 5 seconds to squeeze the utter of a cow. How could that be better than feeding the hungry and giving your wealth to spiritual teachers and stuff?

The Buddha goes on and says more about mindfulness.  But for our purposes, this is the punchline: Metta is a big key to psychological health. And to dig a little deeper into what he's saying, it's actually also a key to the health of the greater society. If everyone loved themselves and loved one another fully, imagine the world we'd have. You wouldn't need to feed anyone; no one would be going hungry to start with. If you have metta in your heart, you will end up helping other people, yourself--and the world--more than you know.

One day I was sitting around contemplating all this, and I thought, "If my life was a project that involved helping people find and develop their metta--even for a moment--it would be worthwhile." And so the Metta Project was born.

All the best,


A few years later, it's interesting to note that the idea I had here still stands. Though loving kindness isn't the only curative aspect in play in life today, a handful of years after I wrote the above post, I still think it's a big one. In this blog, I hope to talk about these various pieces of mental wellness from the integrative perspective that I've come to establish a name for myself by. Feel free to join me.